Robert J MacFarlane

Chelsea and Westminster Hospital NHS Foundation Trust

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Mohammad Waseem

East Cheshire NHS Trust

Eleftherios Tsiridis

Aristotle University of Thessaloniki

Athanasios Mantalaris

Georgia Institute of Technology

Nisarg Mehta

Aintree University Hospitals NHS Foundation Trust

Graham Cheung

University of Liverpool

Thomas D Donnelly

St Vincent’s Private Hospital Brisbane

Michail E. Klontzas

Foundation for Research and Technology Hellas

Simon Matthew Graham

Nuffield Orthopaedic Centre

Manolis Heliotis

Northwick Park Hospital

D. J. Brown

University of Liverpool

Cooperative Institutions

University of Liverpool

University College London

Imperial College London

Aristotle University of Thessaloniki

Royal Liverpool University Hospital

University of Leeds

Macclesfield District General Hospital

Aintree University Hospitals NHS Foundation Trust

Royal Liverpool and Broadgreen University Hospital NHS Trust

East Cheshire NHS Trust

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Traumatic disorders of forearm rotation: anatomy, biomechanics and treatment

British Journal of Hospital Medicine (2014)

Nisarg Mehta Robert J MacFarlane D. J. Brown

The forearm is a complex structure which produces a wide range of movement. Forearm injuries are very common, but many injuries are missed or poorly treated. This article examines the anatomy and biomechanics of the forearm, and describes the important injuries to be recognized.

Biomechanics

10.12968/hmed.2014.75.2.72

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Citations (0)

Anti-inflammatory role and immunomodulation of mesenchymal stem cells in systemic joint diseases: potential for treatment

Expert Opinion on Therapeutic Targets (2013)

Robert J MacFarlane Simon Matthew Graham Peter Davies Nectarios Korres Helen Tsouchnica

Mesenchymal stem cells (MSCs) are multipotent stromal cells characterized by their ability to differentiate into adipocytes, chondrocytes, osteocytes and a number of other lineages. Investigation into their use has increased in recent years as characterization of their immunomodulatory properties has developed, and their role in the pathophysiology of joint disease has been suggested.MSCs demonstrate immunosuppressive functionality by suppressing T- and B-cell responses following activation by cytokines such as IL-6 and IL-1α. They also can be induced to exert pro-inflammatory effects in the presence of acute inflammatory environment due to the actions of TNF-α and IFN-γ. In inflammatory joint diseases such as rheumatoid arthritis, MSCs in bone marrow migrate to joints by a TNF-α-dependent mechanism and may be in part responsible for the disease process. MSCs have also been demonstrated in increased numbers in periarticular tissues in osteoarthritis, which may reflect an attempt at joint regeneration.Clinical applications for MSCs have shown promise in a number of inflammatory and autoimmune disorders. Future work is likely to further reveal the immunosuppressive characteristics of MSCs, their role in the pathophysiology of joint diseases and provide the basis for new avenues for treatment.

10.1517/14728222.2013.746954

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Citations (56)

OCCURRENCE OF TOXIGENIC CLOSTRIDIUM BOTULINUM TYPE C IN THE SOIL OF WETLANDS IN SASKATCHEWAN

Journal of Wildlife Diseases (1987)

Gary A. Wobeser Stanley J. Marsden Robert J MacFarlane

Mouse-lethal toxin identified as that of Clostridium botulinum type C by antitoxin neutralization was present in cultures of 38.0% of 326 soil samples collected from 28 wetlands in Saskatchewan. There was no difference in prevalence of toxicity between samples collected in spring and summer, and no relationship was evident between the occurrence of toxicity and water salinity, marsh type or water depth. There was a strong association between the prior occurrence of avian botulism in a marsh and the presence of toxin in cultures from soil; 59.2% of soil samples from marshes with a known history of botulism produced toxin, whereas only 6.2% of soil samples from marshes with no history of the disease produced toxin. Eight of the 10 soil samples collected from a marsh that had been dry for several years, and from another marsh that had not had a recognized outbreak of botulism for 11 yr produced toxin, indicating a long residual effect after a botulism outbreak. The results suggest that any wetland with a history of botulism is likely to suffer repeated occurrences because of heavy contamination of the soil with spores, and should be managed to control the disease.

Botulism

Clostridium botulinum

Antitoxin

Salt marsh

10.7589/0090-3558-23.1.67

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Citations (27)

Fractures of the Clavicle: An Overview

The Open Orthopaedics Journal (2013)

Thomas D Donnelly Robert J MacFarlane Mathias Thomas Nagy Peter Ralte Mohammad Waseem

Fractures of the clavicle are a common injury and most often occur in younger individuals. For the most part, they have been historically treated conservatively with acceptable results. However, over recent years, more and more research is showing that operative treatment may decrease the rates of fracture complications and increase functional outcomes. This article first describes the classification of clavicle fractures and then reviews the literature over the past decades to form a conclusion regarding the appropriate management. A thorough literature review was performed on assessment of fractures of the clavicle, their classification and the outcomes following conservative treatment. Further literature was gathered regarding the surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted. The majority of recent data suggests that operative treatment may be more appropriate as it improves functional outcome and reduces the risk of complications such as non-union. This is particularly evident in mid shaft fractures, although more high grade evidence is needed to fully recommend this, especially regarding certain fractures of the medial and lateral clavicle.

Conservative Treatment

Conservative Management

Bony union

10.2174/1874325001307010329

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Citations (39)

Impact of the National Lockdown Due to the COVID-19 Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown.

PubMed (2022)

Catrin Morgan Kapil Sugand Thomas Ashdown Nikita Nathoo Robert J MacFarlane

This study assessed the impact of the COVID-19 pandemic on acute upper limb referrals and operative case-mix at the beginning and ease of British lockdown.A longitudinal multicentre observational cohort study was conducted for both upper limb trauma referrals and operative case-mix over a 12-week period (6 weeks from the beginning and 6 weeks from the ease of the national lockdown). Statistical analysis included median (± median absolute deviation), risk and odds ratios, and Fisher's exact test to calculate the statistical significance, set at p ≤ 0.05.There was a 158% (n = 456 vs. 177) increase in upper limb referrals and 133% (n = 91 vs. 39) increase in the operative trauma caseload at the ease of lockdown compared with its commencement. An increase in sporting injuries was demonstrated (p=0.02), specifically cycling (p=0.004, OR=2.58). A significant increase in COVID-19 testing was demonstrated during the ease of lockdown (p=0.0001) with more patients having their management changed during the beginning of the pandemic (9.6% vs. 0.7%, p=0.0001). Of these patients, 47% went on to have delayed surgery within 6 months. No patients who underwent surgery tested positive for COVID-19 infection within 14 days post-operatively and no mortalities were recorded at 30 days.The ease of lockdown has seen upper limb referrals and operations more than double compared to early lockdown. With no patients testing positive for COVID-19 within 14 days of the procedure, this demonstrates that having upper limb surgery during the current pandemic is safe.

Pandemic

10.22038/abjs.2021.53205.2639

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Dementia and osteoporosis in a geriatric population: Is there a common link?

World Journal of Orthopedics (2017)

Candice Downey Adam Young Emily Burton Simon Matthew Graham Robert J MacFarlane

AIMTo determine the existence of a common pathological link between dementia and osteoporosis through reviewing the current evidence base. METHODSThis paper reviews the current literature on osteoporosis and dementia in order to ascertain evidence of a common predisposing aetiology.A literature search of Ovid MED-LINE (1950 to June 2016) was conducted.The keywords "osteoporosis", "osteoporotic fracture", "dementia" and "Alzheimer's disease" (AD) were used to determine the theoretical links with the most significant evidence base behind them.The key links were found to be vitamins D and K, calcium, thyroid disease, statins, alcohol and sex steroids.These subjects were then searched in combination with the previous terms and the resulting papers manually examined.Theoretical, in vitro and in vivo research were all used to inform this review which focuses on the most well developed theoretical common causes for dementia (predominantly Alzheimer's type) and osteoporosis. RESULTSDementia and osteoporosis are multifaceted disease processes with similar epidemiology and a marked increase in prevalence in elderly populations.The existence of

Etiology

10.5312/wjo.v8.i5.412

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Citations (37)

Functional Outcome and Complications at 2.5 Years Following Volar Locking Plate Fixation of Distal Radius Fractures

Journal of Hand and Microsurgery (2015)

Robert J MacFarlane David J. Miller Lynn Wilson Carl Meyer C. Kerin

Distal radius fractures are increasingly treated by internal fixation, but there have been relatively few studies relating to functional outcome at 12 months or more. The aim of this study was to ascertain the patient reported function of the wrist at a minimum of 12 months following fixation of a distal radius fracture, the time taken to return to work, and the complication rate. We conducted a retrospective review of 187 consecutive patients treated by a specialist hand and wrist trauma team at a tertiary referral unit over a 5 year period. Mean age was 57.3 years (range 16–93). Median time to surgery was 4 days (interquartile range 2–9). Median follow up was 31 months (interquartile range 23–41 months). The median PRWE score was 3; (range 0–83). There was no difference in outcome in patients who had surgery delayed by greater than 2 weeks (p>0.05). The median time to return to work was 5 weeks (interquartile range 1–8 weeks). There were 15 complications (8 %) including 3 tendon injuries. We have demonstrated an early return to work in patients who were employed, a low complication rate, and highly favourable functional outcomes at a mean of 30 months postoperatively. We recommend the use of the DVR plate and involvement of a dedicated hand and wrist trauma team for treatment of unstable fractures of the distal radius.

Interquartile range

Distal radius fracture

Malunion

10.1007/s12593-014-0155-1

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Citations (33)

Disease-modifying osteoarthritis drugs:in vitroandin vivodata on the development of DMOADs under investigation

Expert Opinion on Investigational Drugs (2013)

Peter Davies Simon Matthew Graham Robert J MacFarlane Ανδρέας Λεωνίδου Athanasios Mantalaris

Osteoarthritis is a disabling affliction, and disease-modifying osteoarthritis drugs (DMOADs) would be highly desirable adjuncts to symptomatic relief as they may delay the disease process.This study is a comprehensive review of the recent literature on the efficacy of DMOADs in the treatment of OA. In vitro and in vivo evidence was collected using MEDLINE® (1950 to November 2012) and EMBASE (1980 to November 2012) databases. Several drugs have demonstrated DMOAD effects in OA. They can be divided into three groups based on their predominant mode of action: those targeting cartilage, inflammatory pathways and subchondral bone. OARSI guidelines recommend glucosamine and chondroitin sulphates and diacerein as DMOADS, and NICE will recommend glucosamine sulphate in the next update of guidelines. Exploration of improved outcome measures and identification of subgroups of patients most likely to benefit from different DMOADs are likely to be the most important areas of development over the coming years.It is expected that a wider range of prospective clinical studies will be embarked upon in the coming years. Trials including MRI as well as joint space narrowing (JSN) should be designed in a systematic manner, powered with sufficient numbers to demonstrate clinical benefit at different stages of disease.

Drug Development

10.1517/13543784.2013.770837

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Citations (33)

Biodegradable antibiotic delivery systems

Journal of Bone and Joint Surgery - British Volume (2011)

M. El‐Husseiny Shelain Patel Robert J MacFarlane Fares S. Haddad

Bacterial infection in orthopaedic surgery can be devastating, and is associated with significant morbidity and poor functional outcomes, which may be improved if high concentrations of antibiotics can be delivered locally over a prolonged period of time. The two most widely used methods of doing this involve antibiotic-loaded polymethylmethacrylate or collagen fleece. The former is not biodegradable and is a surface upon which secondary bacterial infection may occur. Consequently, it has to be removed once treatment has finished. The latter has been used successfully as an adjunct to systemic antibiotics, but cannot effect a sustained release that would allow it to be used on its own, thereby avoiding systemic toxicity. This review explores the newer biodegradable carrier systems which are currently in the experimental phase of development and which may prove to be more effective in the treatment of osteomyelitis.

Systemic antibiotics

10.1302/0301-620x.93b2.24933

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Citations (119)

A review of the management and outcomes of tarsal navicular fracture

Foot and Ankle Surgery (2019)

Daniel Marshall Robert J MacFarlane Andrew Molloy Lyndon Mason

Navicular bone

Etiology

Stress Fractures

10.1016/j.fas.2019.05.020

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Citations (11)